HMP Peterborough Prison

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed one quality statement from this key question. We found the provider was not providing well led care in accordance with the relevant regulations. Although some systems and processes had improved; concerns remained in relation to patient safety, clinical oversight and risk management.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Shared direction and culture is based on the latest evidence we assessed for the Well-led key question.

The judgement for Capable, compassionate and inclusive leaders is based on the latest evidence we assessed for the Well-led key question.

The judgement for Freedom to speak up is based on the latest evidence we assessed for the Well-led key question.

The judgement for Workforce equality, diversity and inclusion is based on the latest evidence we assessed for the Well-led key question.

At the last inspection we found audits carried out were not effective and did not provide sufficient detail to assess the quality of records or provide meaningful evidence for developing the service. During this assessment we found some improvements. We reviewed several audits and found managers were able to assess the quality of the service and identify areas for improvement. The trust identified that some information collected was not necessary as it did not provide meaningful information, such as numbers of the ‘did not attend’ rates. As a result, the trust changed the way that this was monitored. This shows a more effective way of monitoring outcomes. We reviewed the record keeping audit which showed an average compliance of 95%, this audit helped managers see if some key patient information was missing from notes and how staff can improve. We asked for a copy of the missed medicines audit, but we were not provided with an audit tool that demonstrated leaders could evaluate why patients were missing medicines. Managers said that staff discussed all patients that had missed any critical medicines at the team huddle. However, when we observed a huddle meeting, not all patients were discussed. We reviewed a selection of huddle minutes and found some gaps where staff had not reported patients that had missed medicines. Staff were not always following processes, of talking to the patient and then recording this on the electronic record. On the trust’s CQC action plan, objectives were recorded as complete. However, we found issues that continued to be of concern in relation to clinical observations for substance misuse patients. The mental health team were not completing assessments promptly and oversight for non-attendance of medicine administration. This meant that there was an inaccurate picture of what issues needed to be addressed and did not show leaders a full picture of what still needed to improve and or how to evaluate the service.

The judgement for Partnerships and communities is based on the latest evidence we assessed for the Well-led key question.

The judgement for Learning, improvement and innovation is based on the latest evidence we assessed for the Well-led key question.